What does the RN need to think about when caring for a client with a fluid and electrolyte problem?
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This is a comprehensive review over fluid and electrolytes for nurses. You will learn about the main causes and sign/symptoms of the following electrolytes: Potassium, Sodium, Chloride, Phosphate, Magnesium, and Calcium. If you would like to learn about these individually along,
with their signs and symptoms you can check out this fluid and electrolytes playlist. Don’t forget to take the fluid and electrolytes quiz and to watch the lecture on fluid and
electrolytes after reviewing this material. We need a proper balance of fluids and electrolytes in our body to maintain life (not too high or too low…just the right amount). In fact, our body consists of 70% water and below you can see the function of water in our body. However, this water in our body is not just plain water. It consists of so many substances such as electrolytes.  What are electrolytes? These are substances that once they enter and dissolve in water (hence our blood) they produce an electrical charge (become ions), which helps with electrical signaling in the body and other important processes. Our body is really “electric” because a lot of the processes it does requires electrical signaling. For instance, we need a balanced amount of electrolytes for the following functions:
When certain electrolyte imbalances occur some of the functions above will present abnormally. For example with “contraction of muscles”, if certain imbalances occur muscle spasms can present. In addition, the heart (which is a muscle) can cause an abnormal EKG (which is a test that assesses the electrical activity in the heart). How does our body balance electrolytes? We consume these electrolytes through our diet via the foods and drinks we consume. Our kidneys filter and reabsorb what electrolytes we need and don’t need in our body. The kidneys do this via the nephrons in the kidneys, which are the functional parts of the kidney. Therefore, if a patient is experiencing kidney failure these electrolytes will become imbalanced (many times too high and the patient will need dialysis to help correct the imbalance). Other ways electrolyte levels can become imbalanced is if they are lost in the body via an exit route. Electrolytes at present in the urine, sweat, emesis, blood, and stool (really any type of body substance). Plus, certain medications can affect electrolyte levels along with trauma like burns or other disease processes. So, let’s learn about the 6 major electrolytes that make up our body. Sodium:What is Sodium? It’s a very important electrolyte that helps regulate water inside and outside of the cell. And it helps with muscle contraction and transmission of nerve impulses. Normal levels: 135-145 mEq/L Sodium mainly hangs out in the OUTSIDE of the cell in fluid and helps water move inside and outside the cell as needed. So for example, when blood levels of sodium drop in the blood it affects the cells because suddenly water starts to rush into the cell. This causes the cell to swell. On the flip side, when too much sodium is outside the cell, water from inside the cell starts to leave and the cell shrinks. Hyponatremia Low sodium in the blood (less than 135 mEq/L) Causes:
Signs and Symptoms of Hyponatremia Remember “SALT LOSS” Seizures & Stupor (decrease in consciousness…confusion) Abdominal cramping Lethargic Tendon reflexes diminished, trouble concentrating Loss of urine & appetite Orthostatic hypotension, overactive bowel sounds Shallow respirations (happens late due to skeletal muscle weakness) Spasms of muscles Hypernatremia High sodium in the blood (greater than 145 mg/dL) Causes:
Signs and Symptoms of Hypernatremia Remember: “No FRIED foods for you!” (too much salt) Fatigue Restless, really agitated (confused….central nervous system changes) Increased reflexes (progress to seizures and coma) Extreme thirst (*big sign) Decreased urine output, dry mouth/skin ChlorideWhat is Chloride? Chloride plays a role with acid-base balance in the body along with balancing the fluids in our body by working with sodium to maintain osmotic pressure. Also, sodium and chloride really go together, and if sodium is decreased, chloride is likely to be decreased as well. Furthermore, chloride is needed to make hydrochloric acid, which plays a huge role in food digestion. The kidneys help maintain chloride blood levels by taking what you don’t need and excreting it in the urine. Chloride is also excreted through sweating and gut juices. Therefore, if chloride is imbalanced (especially high) it may be a kidney problem because specific parts of the nephron remove chloride from the blood and place it in the urine (if the kidneys aren’t functioning right this can’t happen so more stays in the blood). Normal level: 95-105 mEq/L Hypochloremia Low chloride levels in the blood ( <95 mEq/L) Causes:
Signs and symptoms of hypochloremia tend to be associated with whatever is causing the low level (rather than the level being low itself, so you want to look at what is causing the low level to identify the signs and symptoms) and tends to look like hyponatremia signs and symptoms but you may see:
Hyperchloremia High chloride in the blood ( >105 mEq/L) Causes:
Signs and Symptoms tend to be associated with whatever is causing the high level (rather than the level being high itself) so you want to look at what is causing the high level to identify the signs and symptoms) and it may look like hypernatremia and acidosis signs and symptoms. PotassiumWhat is Potassium? It’s an electrolyte that is mainly found in the intracellular part of the cell (inside of the cell) compared to the extracellular (outside of the cell), which is where sodium is mainly found. Sodium and potassium are affected by each other. Typically, if the sodium levels increase (potassium decreases) and sodium level decreases (potassium increases). Therefore, potassium helps with fluid balance like sodium, especially inside the cell. In addition, potassium is responsible for nerve impulse conduction and muscle contraction. Normal levels: 3.5-5 mEq/L Hypokalemia: Low potassium in the blood (<3.5 mEq/L) Causes:
Signs and Symptoms of Hypokalemia: Try to remember everything is going to be SLOW and LOW. Don’t forget potassium plays a role in muscle and nerve conduction so muscle systems are going to be messed up and affect the heart, GI, renal, and the breathing muscles for the lungs. 7 L’s (Low)
Hyperkalemia High potassium in the blood (>5 mEq/L) Causes:
Signs and Symptoms of Hyperkalemia: “Murder” Muscle weakness Urine output little or none (renal failure) Respiratory failure (due to muscle weakness) Decreased cardiac contractility (weak pulse/low HR) Early: muscle twitches/cramps Rhythm changes: Tall peaked T-waves, prolonged PR interval (increased higher p-wave not visible) CalciumWhat is Calcium? Calcium plays a huge role in bone and teeth health along with muscle contraction/nerve transmission, cell, and blood clotting. Calcium is absorbed in the GI system (so a diet rich in calcium is essential for maintaining calcium blood levels), and it’s stored in the bones. Therefore, if blood levels drop the bones will release some calcium in the blood to help maintain levels, but this can be unhealthy overtime and lead to osteoporosis. To maintain balanced calcium blood levels, it has to have some help from: Vitamin D helps play a role in calcium absorption in the GI system. In addition, hormones play a role with maintaining balanced calcium levels like: Parathyroid hormone (PTH): it’s found in the parathyroid gland Calcitonin: it’s found in the thyroid gland Therefore, any problem with these hormones or the structures that produce these hormones can lead to an imbalance of calcium levels. In addition, phosphorus and calcium affect each other in the opposite way. For instance, if phosphorus levels are high in the blood, calcium will decrease and vice versa. They are always doing the opposite (remember this because it is important for the causes of hypocalcemia). Normal calcium level: 8.5 to 10.5 mg/dL Hypocalcemia: Low calcium in the blood (<8.5 mg/dL) Causes:
Signs and Symptoms of Hypocalcemia Muscles and nerves will majority be affected “CRAMPS” Remember “CRAMPS” Convulsions Reflexes hyperactive Arrhythmias (prolonged QT interval) Muscle spasms in calves or feet (tetany) Positive Signs
Sensation of tingling and numbness (paresthesia)…fingers/toes Hypercalcemia: High calcium in the blood (>10.5 mg/dL) Causes:
Signs and Symptoms: Overall WEAK” Weakness of muscles (profound) EKG changes shortened QT
interval Absent reflexes (decreased), altered mental status, abdominal distention from constipation Kidney Stone formation MagnesiumWhat is Magnesium? Magnesium is another major ion found inside the cell just like potassium. Magnesium plays a big role with muscle and nerve function. For example, it plays a big role with how ATP works with the sodium-potassium pump. Magnesium helps by binding with ATP (which needs mag ions to function) so 3 sodium ions can move out of the cell and 2 potassium ions can move in the cell…without proper mag levels this function fails to work properly. Also, mag helps with muscle relaxation. Calcium and mag are competitors in muscle contraction. In a nutshell, calcium plays a vital role in muscle contraction, and magnesium challenges the binding spot of calcium to cause muscles to relax. Therefore, without enough magnesium to calm muscle contractions down, cramping and spasms may occur. Plus, magnesium is vital for how nerves transmit signals, how our vessels work to maintain blood pressure, and how the heart muscle contracts. Magnesium is absorbed in the gut, specifically the small intestine (keep this in mind…because if there is a problem with the small intestine, magnesium absorption can be affected). In addition, it’s excreted through the kidneys. When magnesium levels are imbalanced, many times other electrolytes imbalances will occur as well (specifically potassium and calcium levels). Normal magnesium level: 1.5-2.5 mg/dL Hypomagnesemia: Low magnesium level in the blood: (< 1.5 mg/dL) Causes:
Signs and Symptoms of Hypomagnesemia When magnesium is too low to calm things down, excitability will be occurring (opposite for hypermagnesemia). “Twitch” Trouesseau’s Sign & Chvostek’s Sign (positive due to hypocalcemia) Weakness Increased deep tendon reflexes Torsade’s de pointes (abnormal heart rhythm that leads to sudden cardiac death…seen in alcoholism) Tetany (seizures) and other EKG changes that go along with calcium and potassium decrease Calcium and potassium levels low (presents together) Hypertension Hypermagnesemia: High magnesium level: > 2.5 mg/dL Causes:
Signs and Symptoms of Hypermagnesemia Every system of the body is “Lethargic” (opposite of hypomagnesemia where the body systems are experiencing hyperexcitability) Note: You will typically only see symptoms in severe cases of hypermagnesemia (mild cases the patient may be asymptomatic) Lethargy (profound) EKG changes with prolonged PR & QT interval and widened QRS complex Tendon reflexes absent/grossly diminished Hypotension Arrhythmias (bradycardia, heart blocks) Red and hot face (flushing) GI issues (nausea, vomiting) Impaired breathing (due to skeletal weakness) Confusion (neuro impairment) PhosphateWhat is phosphate? Normal phosphate level: 2.5-4.5 mg/dL Phosphate helps build bones/teeth and plays a role in nerve/muscle function. Majority of the phosphate is stored in the bones. Therefore, it plays a vital role in bone and teeth health. It’s absorbed through food we eat and is excreted through the kidneys (if there is a renal insufficiency, phosphate levels can be high because the kidneys are failing to excrete it). Also, the parathyroid gland plays a role in the regulation phosphate just like it did with calcium. It’s important to remember that calcium and phosphate can many times influence each other in opposite ways. For example, when calcium levels increase, in turn phosphate levels decrease (vice versa). Vitamin D plays an important role in phosphate absorption as well. Hypophosphatemia Low phosphate level in the blood (<2.5 mg/dL) Causes:
Signs and Symptoms of Hypophosphatemia Typically seen when the levels are severely low (not mildly) “Bone” Bone pain and fractures Osteomalacia (softening of bones) results in bowing of the legs…affect growth in children (shorter) Neuro status changes (irritability, confusion, seizures) Erythrocyte destruction (red cells destroyed leading to hemolytic anemia) Hyperphosphatemia High phosphate level in the blood (>4.5 mg/dL) Causes:
Signs and Symptoms of Hyperphosphatemia Hypocalcemia will be seen Convulsions Reflexes hyperactive Arrhythmias Muscle spasms in calves or feet, tetany, seizures Pruritus* (itching…found in many patient with renal failure) Signs of Chvostek and Trousseau’s What are nursing interventions for electrolyte imbalance?Nursing Interventions for Risk for Electrolyte Imbalance. Supply balanced electrolyte IV solutions as directed. Lactated Ringer's solution has an electrolyte concentration similar to that of extracellular fluid. Isotonic saline (0.9% sodium chloride) may contribute to hypernatremia if used in a long period of time.
What should be included in an assessment with a patient with fluid and electrolyte imbalances?CURRENT STATUS. Which primary functions would the nurse include when teaching the patient about electrolytes within the body?C. (Correct)Altering the action potential of nerve fibers is a primary function of electrolytes within the body. D. (Correct) Maintaining fluid osmolality is a primary function of electrolytes within the body.
How do you maintain fluid and electrolyte balance?Several strategies can help keep your electrolytes in balance:. Eat a balanced, healthy diet which includes foods that contain electrolytes.. Drink plenty of water, but don't overdo it. ... . Don't overuse over-the-counter diuretics or take them for a prolonged period of time without your doctor's approval.. Don't overuse salt.. |
